NRSG376 Intensive Simulations Online Assignment Solutions

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You have been provided with the details of 3 case scenarios on which you are required to complete the following tasks:

1. Provide a detailed discussion of the pathophysiology and symptom profile of each of the patient diagnosis.
2. Provide a comprehensive overview of each patient’s clinical condition is to be included as well as an overview of the expected treatments that the patient would be receiving. This should take the form of a nursing care plan.
3. Provide an overview of each of the medications that the patient is currently prescribed including why they are prescribed this medication, the category of the drug, actions and indications, adverse effects and nursing consideration
4. List and provide rationales of 5 nursing priorities for each patient
5. Discuss the interprofessional referrals to physiotherapy, occupational therapy, speech pathology or social work required for the patient. Provide a rationale to why you would need these professions to support best patient outcomes.
6. List 2 discharge considerations for this patient.

The case studies are the same case studies you have experienced in the Simulation Intensives. Your response to the above questions can take the form of a detailed nursing care plan or you may use the template/table provided. It is essential however that appropriate and current peer-reviewed references are used to support the discussion.

CASE 1 – ALEX FREEMAN DOB 12/12/1981

Presenting Condition

Alex Freeman is a middle-aged woman. Alex has returned from theatre today following a left shoulder arthroscopy for repair of torn rotator cuff. Her left arm has been placed in an immobiliser sling. Post-op instructions include guided passive mobilisation of left shoulder and hourly left-hand neurovascular observations.

Past Medical History

Alex has suffered from left shoulder pain as a result of playing netball during her early twenties. Her left shoulder recently got injured during a netball game and since then Alex has suffered from left shoulder pain.

 Regular Medications

Nonsteroidal anti-inflammatory drug (Celebrex 100mg Tablets bd).

Social History

Alex is married and has two teenage boys. She works in retail.

Currently

RTW post L) Rotator Cuff surgery. Post-op instructions are for hourly neurovascular observations. Alex’s left hand is currently pink and warm with a strong palpable radial pulse. For pain she has been charted to receive a Fentanyl PCA intravenous infusion set to deliver a bolus dose of 20mcg at five-minute intervals. She has also been prescribed to receive Tramadol 50mg tablets immediate release every six hours to commence when PCA ceases. The surgeon has requested to be contacted if there are any changes in her condition.

Observations

Temperature	36.9oC
Pulse/ Heart Rate	80/min Regular
Respiration	18/min
Blood Pressure	135/82
SpO2	98% 3L NP
Pain Score	4/10 Rest (dull surgical pain)
Neurovascular observation	C=PaleW= Cool

M=Impaired

S=Numb

Cap Refill= <2 sec

Pulse Weak

1. Please provide a detailed discussion of the pathophysiology and symptom profile of Alex’s diagnosis.
2. Please provide the following information. This should take the form of a nursing care plan.
   • a comprehensive overview of Alex’s clinical condition.
   • list and provide rationales of 5 nursing priorities for Alex
   • an overview of the expected treatments that Alex would be receiving should be included.
3. An overview of the medications that Alex is currently prescribed including why she is prescribed this medication, the category of the drug, actions and indications, adverse effects and nursing considerations.
4. Discuss the interprofessional referrals to physiotherapy, occupational therapy or speech pathology required for these patients. Provide a rationale to why you would need these professions to support.
5. List 2 discharge considerations for Alex

CASE 2 – LESLIE JACKSON DOB 22/5/1945

Presenting Condition

Leslie is a 78-year-old female who has sustained a left-sided ischaemic stroke 2 days ago. Medical imaging of her brain showed an acute infarct due to a thrombus involving the left middle cerebral artery (MCA) territories. On arrival to the Emergency Department, Leslie’s son provided signed consent provided for her to receive thrombolytic therapy (Alteplase), which was completed. She has been transferred from ED to the ward. Leslie has severe right-sided upper limb weakness and mild lower limb weakness. She continues to display mild dysphasia (i.e. word finding difficulties) and mild dysarthria (i.e. slurred speech) which makes it difficult for people to always understand what she is saying. Added to the communication difficulties Leslie is experiencing short-term memory loss that only serves to increase her feelings of frustration. She is also presenting with a right sided homonymous hemianopia which is impacting her ability to read (i.e. hospital menu/forms). A swallowing assessment is required to performed by the speech pathologist to determine if it is safe for Leslie to swallow tablets.

Past Medical History

• High blood pressure
• High cholesterol
• Osteoporosis

Regular Medications

• Panadol 500mg tablets PRN qid
• Atenolol 50mg tablet bd
• Atorvastatin 80mg tablet nocte
• Aspirin 300mg tablet daily
• Heparin 5000 S/C units bd

Social History

She is a widow with two sons (Michael and Greg). Normally lives independently. 

Currently

Leslie is having trouble finding words, and her speech is unclear. She is essentially unable to move her right arm other than a small amount of movement at the shoulder (shrugging shoulder). Leslie is frustrated at not being able to do things independently. Leslie requires a physiotherapy, speech pathology and occupational therapy review.

Observations

Temperature	36.3oC
Pulse/ Heart Rate	92/min Regular
Respiration	18/min
Blood Pressure	152/92
SpO2	98% RA

1. Please provide a detailed discussion of the pathophysiology and symptom profile of Leslie’s diagnosis.
2. Please provide the following information. This should take the form of a nursing care plan.
   • a comprehensive overview of Leslie’s clinical condition.
   • list and provide rationales of 5 nursing priorities for Leslie.

   an overview of the expected treatments that Leslie would be receiving should be included.

3. Provide an overview of the medications that Leslie patient is currently prescribed including why she is prescribed this medication, the category of the drug, actions and indications, adverse effects and any nursing considerations.
4. Discuss the interprofessional referrals to physiotherapy, occupational therapy or speech pathology required for these patients. Provide a rationale to why you would need these professions to support.
5. List 2 discharge considerations for Leslie

CASE 3 – CHARLIE ROBINSON DOB 22/5/1945

Presenting Condition

Charlotte ‘Charlie’ Robinson is a young woman who was admitted to the Emergency Department (ED) yesterday evening having been found by her mum unconscious. It is believed Charlie took an intentional polydrug overdose of approximately 20 x 500mg Paracetamol tablets. She is also suspected of having taken a number of Olanzapine tablets. On arrival to ED she was drowsy and unable to maintain her airway requiring intubation and ventilatory support. Ingestion of tablets was estimated to have been less than two hours from the time she was found unconscious. So to reduce further drug absorption activated charcoal was administered down a nasogastric tube and Acetylcysteine infusion commenced to protect Charlie from possible liver damage. Treatment continued until her serum paracetamol concentration levels were below toxic levels. Blood results showed normal serum Alanine Aminotransferase (ALT) levels and a Prothrombin Time (PT) within normal limits suggesting no permanent liver damage had occurred. Over several hours her condition continued to improve and a decision was made to stop sedation and to allow her to wake up. Having spent most of the night in ED she was extubated in the morning and transferred to the ward. After being seen by the on-call psychiatrist, she was judged not to be a high-risk of self-harm but has remained on the ward waiting to be transferred to Graylands mental health hospital for further management as a voluntary patient. Transport has been booked for 12pm.

Past Medical History

At the age of 17 Charlie was hospitalised in a child and Adolescent Mental Health Clinic because of a drug-induced psychosis. Her continued use of substances such as marijuana and amphetamines has made her condition worse. Symptoms of delusional behaviour and reporting of hallucinations are complicated by mood swings between depression and mania.

Charlie first presented to the ED accompanied by her mother with a one-week history of being in a highly agitated state. Over the past week Charlie had fluctuating mood swings. During this time she had not slept and hardly had anything to eat or drink. The day before Charlie presented to ED her mum had noticed a sudden change in mood. She began to express suicidal thoughts and an impulse for self-harm. Mum is not exactly sure how many tablets Charlie had taken but the two packets of Panadol she had recently purchased were empty when she found Charlie collapsed on the floor.

Regular Medications

• Olanzapine 10mg tablet od
• Lithium 300mg tablet tds

Social History

A conversation with Charlie’s mum reveals that as a child, Charlie was always a bit eccentric “in her own world”. This manifested itself during adolescence with Charlie finding it increasingly difficult to engage with her peers and establish friendships. Charlie was regularly attending high school until at the age of 14 “she got mixed-up with the wrong sort” and started to take drugs and abscond from school. The situation worsened when Charlie started a relationship with her ex-boyfriend Gary. The relationship began to deteriorate when Gary started to beat her up. She eventually ended the relationship, but Gary found this difficult to accept. Charlie has now a restraining order placed on her ex-boyfriend. Since then Gary has made several unsuccessful attempts to make contact with her (hospital security has been notified that ex-boyfriend is not allowed to visit Charlie should he make an attempt to do so). Last year Charlie decided to move back and live with her mum again. Mum is supportive of her daughter’s attempts to stop recreational substance abuse. Charlie has not seen her dad since he left home when she was four years old. 

Currently

Charlie has an IV infusion of N-Acetlycysteine Infusion 22mg/100mL Normal Saline

 to reverse the effects of the Paracetamol. Charlie is lying quietly on the bed in a depressive state. Charlie’s mood is one that expresses emptiness, sadness and worthlessness. It is not uncommon for Charlie to start crying unexpectantly.

Observations

Temperature	36.2oC
Pulse/ Heart Rate	75/min Regular
Respiration	16/min
Blood Pressure	115/65
SpO2	98% RA

 

1. Please provide a detailed discussion of the pathophysiology and symptom profile of Charlie’s diagnosis.
2. Please provide the following information. This should take the form of a nursing care plan
   • a comprehensive overview of Charlie’s clinical condition.
   • list and provide rationales of 5 nursing priorities for Charlie
   • an overview of the expected treatments that Charlie would be receiving should be included.
3. Provide an overview of the medications that Charlie patient is currently prescribed including why she is prescribed this medication, the category of the drug, actions and indications, adverse effects and any nursing considerations.
4. Discuss the interprofessional referrals to physiotherapy, occupational therapy or speech pathology required for these patients. Provide a rationale to why you would need these professions to support.
5. List 2 discharge considerations for Charlie.

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